Impact Of Diaphragm Thickness By Ultrasound On Weaning Success Prediction Of From Mechanical Ventilation

Abstract

Background/Objectives: Weaning failure from mechanical ventilation (MV) remains a critical challenge in intensive care, affecting 20%–40% of critically ill patients. Diaphragm dysfunction is a key contributor to weaning failure and prolonged MV dependence. This study aimed to evaluate the utility of diaphragm thickness (DT) measured by point-of-care ultrasonography (POCUS) as a predictor of weaning success from MV in ICU patients.  Materials and Methods: A prospective observational study was conducted on 100 mechanically ventilated patients admitted to three hospitals in Duhok, Iraq. Diaphragm thickness was measured ultrasonographically before and after a spontaneous breathing trial (SBT). Clinical, laboratory, and ventilatory parameters were recorded. Patients were classified as weaning success (n=45) or weaning failure (n=55). Statistical analyses included t-tests, Chi-square, Receiver Operating Characteristic (ROC) curve analysis, and Pearson/Spearman correlations.  Results: Diaphragm thickness before and after weaning was significantly greater in the success group compared to the failure group (p<0.001). ROC analysis demonstrated that diaphragm thickness before weaning had an AUC of 0.742 (sensitivity 73.3%, specificity 67.3%) and after weaning an AUC of 0.856 (sensitivity 82.2%, specificity 76.4%). Age and number of ventilation days were significant predictors of weaning outcome.  Conclusion: Diaphragm thickness measured by ultrasound is a reliable, non-invasive predictor of weaning success from mechanical ventilation. Post-SBT diaphragm thickness demonstrated superior predictive accuracy. Integration of diaphragm ultrasonography into routine ICU weaning protocols is recommended.